From the Guidelines
For post-nasal drip, I recommend using a combination of saline nasal spray and either fluticasone propionate (Flonase) or azelastine (Astelin), as this combination has been shown to be effective in reducing symptoms of post-nasal drip, with minimal side effects, as supported by studies such as 1.
Recommended Treatment
To manage post-nasal drip, start with saline spray 2-3 times daily to flush mucus and moisturize nasal passages.
- Follow this with a steroid spray like fluticasone (1-2 sprays per nostril once daily) to reduce inflammation.
- For more severe cases, adding an antihistamine spray like azelastine (1-2 sprays per nostril twice daily) can be effective, especially if allergies are contributing to your symptoms. These medications work together by addressing different aspects of post-nasal drip:
- Saline physically clears mucus
- Steroids reduce the inflammation causing excess mucus production
- Antihistamines block the allergic response if relevant
Proper Technique
For best results, use the saline spray first, wait 5-10 minutes, then use the medicated spray(s).
- Proper technique is important: tilt your head forward slightly, aim the spray toward the outer wall of the nostril, and avoid sniffing forcefully after spraying. If symptoms persist beyond 2-3 weeks of consistent use, consult a healthcare provider as you may need additional treatment or have an underlying condition requiring different management, as suggested by 1 and 1.
Additional Considerations
Intranasal anticholinergics, such as ipratropium bromide, may also be effective in reducing rhinorrhea, as shown in studies like 1, but their use should be considered on a case-by-case basis due to potential side effects and interactions with other medications.
- The combination of ipratropium bromide nasal spray and an intranasal corticosteroid has been shown to be more effective than either drug alone in treating rhinorrhea, without increasing adverse events, as noted in 1 and 1.
From the FDA Drug Label
Astelin® Nasal Spray significantly improved a symptom complex comprised of rhinorrhea, post nasal drip, nasal congestion, and sneezing. Astelin® Nasal Spray is indicated for the treatment of the symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion and postnasal drip in adults and children 12 years and older.
Good nasal sprays combined for post nasal drip may include Azelastine (IN), as it has been shown to significantly improve symptoms of postnasal drip in patients with vasomotor rhinitis 2. The drug label indicates that Azelastine (IN) is indicated for the treatment of symptoms of vasomotor rhinitis, including postnasal drip, in adults and children 12 years and older 2.
- Key benefits of using Azelastine (IN) for postnasal drip include:
- Significant improvement in symptoms of postnasal drip
- Indicated for treatment of vasomotor rhinitis symptoms, including postnasal drip However, it is essential to consult a healthcare professional to determine the best course of treatment for individual cases of postnasal drip.
From the Research
Good Nasal Sprays for Post Nasal Drip
- Azelastine nasal spray is a fast-acting, efficacious, and well-tolerated H1-receptor antagonist for the treatment of rhinitis, including post-nasal drip 3, 4, 5.
- Azelastine nasal spray has a rapid onset of action and improves nasal symptoms associated with rhinitis, such as nasal congestion and post-nasal drip 3, 4, 5.
- Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray may provide greater efficacy than either agent alone in treating patients with seasonal allergic rhinitis, including post-nasal drip 3, 4, 6.
- A novel intranasal formulation of azelastine hydrochloride and fluticasone propionate (MP-AzeFlu) has been shown to improve nasal symptoms of allergic rhinitis, including post-nasal drip, to a significantly greater degree than azelastine or fluticasone propionate alone 7.
Benefits of Combination Therapy
- Combination therapy with azelastine and fluticasone propionate may provide a substantial therapeutic benefit for patients with seasonal allergic rhinitis compared to therapy with either agent alone 6.
- MP-AzeFlu has been shown to improve all individual AR symptoms, including nasal congestion relief, which is generally accepted as the most bothersome symptom for AR patients 7.
- MP-AzeFlu has a rapid onset of action, within 30 minutes, and provides clinically important improvement in the overall Rhinoconjunctivitis Quality of Life Questionnaire score 7.
Safety and Tolerability
- Azelastine nasal spray is well tolerated in both adults and children with allergic rhinitis, with bitter taste being the most common side effect reported by patients 3, 4.
- The incidence of somnolence may be reduced with the recommended administration technique of azelastine nasal spray 4.
- MP-AzeFlu has been shown to be safe and well tolerated in clinical studies, with a favorable safety profile 7.